Fluctuating lymphocyte chimerism, tolerance and anti-tumor response in a patient with refractory lymphoma receiving nonmyeloablative conditioning and a haploidentical related allogeneic bone marrow transplant

Cytokines Cell Mol Ther. 2002 Dec;7(2):43-7. doi: 10.1080/13684730412331302054.

Abstract

A 51-year-old patient with refractory non-Hodgkin lymphoma (NHL) received non-myeloablative conditioning and a two of six (A, B, DR) human leucocyte antigen (HLA) mismatched donor BMT. Post-BMT lymphocytes showed fluctuating T- and natural killer (NK)-cell chimerism, which culminated in mainly donor lymphocytes by Day + 100. Changes in lymphocyte chimerism correlated with anti-donor and anti-host responses in mixed lymphocyte reaction (MLR). On Day + 100, a strong anti-host response was observed in MLR in the absence of graft-versus-host disease (GVHD), together with near complete regression of the patient's lymphoma. A mild chronic GVHD later developed and, eventually, by 680 days post-BMT, the lymphoma had relapsed and MLR reflected a state of global immune unresponsiveness. These observations demonstrate evolving host-versus-graft and graft-versus-host tolerance that correlates with fluctuating lymphoid chimerism and graft-versus-lymphoma (GVL) effects, in the absence of severe GVHD. Eventual lymphoma relapse temporally correlated with a generalised immunosuppressed state.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Bone Marrow Transplantation*
  • Clinical Trials as Topic
  • Flow Cytometry
  • Humans
  • Kinetics
  • Lymphocyte Subsets
  • Lymphocytes / immunology*
  • Lymphocytes / metabolism*
  • Lymphoma / immunology*
  • Lymphoma / therapy*
  • Male
  • Middle Aged
  • Recombinant Fusion Proteins / metabolism
  • Time Factors
  • Transplantation Conditioning
  • Transplantation, Homologous*

Substances

  • Recombinant Fusion Proteins